Medicare: Special needs of Carlsbad's aging population makes it tough to prescribe generic drugs, doctors say

CARLSBAD >> A new report which analyzes the Medicare Part D drug prescription program revealed that New Mexico is helping to keep costs down by prescribing generic brand drugs for patients.

In fact the data showed that New Mexico was in the top 5 when it came to prescribing generic drugs over costly brand-name prescriptions, saving the program millions. But while NM is top in generics, prescribers say that costs for prescription drugs, generic or name brand, are still out of reach for some Carlsbad patients.

Analysis done by ProPublica revealed that over prescribing of name brand drugs, when generic substitutions exists has cost American taxpayers billions of dollars.

But when talking dollars not all big numbers lead directly to brand name drugs.

In ProPublica's list of top family medicine prescribers in New Mexico is Carlsbad doctor Kim Lark, who in 2011 had 17,951 claims, making her second in the state when it comes to number of dollars spent on Medicare Part D drugs.

"Ninety-nine percent of the time I try to prescribe generics," said Lark, noting that her patients are often those in economic straits.

Lark only prescribed brand name drugs 17 percent of the time in 2011, and most of those involved patients who returned to her for refills after they were prescribed the drugs by a specialist. Lark has been practicing in Carlsbad for several years and says that the trend she has seen in her patients has been moving them toward generics, more often because of a shortfall in disposal income.

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Lark had 771 registered Medicare patients in 2011, nearly double the amount of her nearest colleagues who are providers.

In comparison, internal medicine practitioner Michael Sims prescribed brand name drugs 21 percent of the time to his 362 Part D patients. Sims practice generated $475,000 in total cost of claims filled.

"Patients use to say they wanted name brand drugs and now I hear 'I want generics'," said Lark.

While brand name drugs make up a larger percentage of the total cost, mental health nurse practitioner Ronald Haugen says that often generics have high price tags too.

"You can sometimes have generics that cost several hundred dollars. Just because it's cheaper doesn't mean it's inexpensive," Haugen said.

He cites common mental health drugs such as Wellbutrin which is used to treat depression. A 30 day supply of 100mg Wellbutrin costs more than $130 while its generic Bupropion is $30. While that may seem a reasonable price, Haugen says for some patients it is still a financial stretch.

"If everything were on Walmart's $4 list we would be great with it," Haugen said, but many times the drugs needed to treat mental health conditions are simply not financially feasible.

And for some Carlsbad residents the cheaper generics are simply not available.

"There are always those cases that you have, where patients can't be treated because there are no generics to treat their condition," said Southwest Pharmacy owner Jack Volpato.

In many cases, he said, patients who fill prescriptions at his stores understand they will be receiving a generic drug.

Specialists are among the top prescribers of brand name drugs in the southeastern portion of the state, he said. As a retirement community with an aging population, Carlsbad has specialized needs that require brand name drugs, he said.

The top prescribers of Medicare Part D psychiatry drugs in New Mexico has Neal Musselman, a psychiatrist, in fourth with 4,365 prescriptions totaling $699,000 in cost.

And Haugen tops NM's list in mental health with 4,373 prescriptions and $500,000 in costs.

Pulmonary disease specialist Alan Orellana, who now practices in Las Cruces, has a chart-topping 67 percent as a result of his 84 Part D patients filling 359 claims. The total cost generated by Orellana's prescribed brand name drugs was $68,800.

Lark was also in the top five prescribers of Omeprazole, which data indicate is the fifth most prescribed name brand drug in NM.

Half of the top 10 name brand drugs prescribed in New Mexico are to treat high blood pressure and cholesterol conditions.

"The reality is that 98 percent of our patients don't have the disposal income for any prescriptions," Lark said. According to her, a large number of patients will go without filling prescriptions.

"Is (cost) the first things on our minds? Probably not," said Haugen, who said that prescribers should be considering patient needs first and foremost.

Cost, while outside prescribers control he says, should remain a factor when discussing treatment option with patients.

In 2011 the total amount of Medicare Part D claims filed in NM by internal, general and family doctors in Carlsbad totaled over $3.2 million.

Approximately 60,000 of New Mexico's 2.6 million prescriptions were filled in Carlsbad.

Part D was created in 2006 as a way to subsidize drug costs for low income patients. Now in its eighth year there are over 29 million beneficiaries with 1.2 billion prescriptions written as part of Medicare Part D in 2011.

New Mexico is one of 18 states where primary care physicians prescription of name brand drugs fall within 18 to 20 percent of total claims -- pretty average when you consider states such as New Jersey, where name brand prescriptions are 28 percent of all drugs prescribed.

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